Nkhani
Methylene blue pa matenda a Lyme: zotsatira za mu labotale ndi umboni wa kafukufuku wa odwala
Chotengera chokulitsira tizilombo si wodwala. Kusiyana kumeneko kumafotokoza pafupifupi zonse zimene zimanenedwa zokhudza methylene blue ndi matenda a Lyme.
Tiyerekeze kuti owerenga awiri aona mawu amodzi: ofufuza “anathetseratu” mabakiteriya a Lyme pogwiritsa ntchito mankhwala osakaniza. Wowerenga mmodzi amamva kuti m'chotengera chagalasi simunapezeke tizilombo kwa milungu iwiri. Winayo amamva kuti odwala omwe anali ndi kutopa anachira. Kumvetsa kwa mitundu yonse iwiriyi kumaoneka kwachibadwa. Koma koyamba kokha n'kogwirizana ndi zimene kuyesa kwa mu labotale kunayeza.
Nkhaniyi imasiyanitsa mfundo ziwirizi. Imaunika zimene methylene blue inachita ku Borrelia burgdorferi wokulitsidwa mu labotale, zimene zinachitika pamene inali m'gulu la mankhwala ambiri operekedwa kwa odwala, komanso chifukwa chake palibe mwa zotsatirazi chomwe chimayankha kuti munthu ayenera kumwa methylene blue kwa nthawi yaitali bwanji chifukwa cha Lyme.
Lyme imayambitsidwa ndi mabakiteriya, choncho umboni wokhudza tizilombo toyamwa m'thupi sungagwiritsidwe ntchito pa iyo
Matenda a Lyme amayambitsidwa ndi Borrelia burgdorferi, bakiteriya wooneka ngati chinthu chopindapinda amene amafalitsidwa ndi nkhupakupa. Chithandizo chovomerezeka chimagwiritsa ntchito mankhwala opha mabakiteriya monga doxycycline, amoxicillin, kapena cefuroxime, monga tafotokozera mu malangizo a Lyme a 2020 ochokera ku IDSA, AAN, ndi ACR.
Kudziwa kuti chimenechi ndi bakiteriya n'kofunika chifukwa methylene blue ili ndi mbiri ina yogwiritsidwa ntchito polimbana ndi tizilombo toyamwa m'thupi. Inafufuzidwa polimbana ndi tizilombo toyambitsa malungo, ndipo nthawi zina imakambidwa pa Babesia, tizilombo toyamwa m'thupi tofalitsidwa ndi nkhupakupa tomwe tingapezeke pamodzi ndi Lyme. Zotsatira zolimbana ndi tizilombo toyamwa m'thupi sizitsimikizira kuti imagwira ntchito mofanana pa Borrelia. Tizilomboti timasiyana pa kapangidwe, kagwiritsidwe ka zinthu m'thupi, malo amene mankhwala amakhudza, ndi mbali ya thupi imene timapatsira matenda. Kufotokoza kwathu mmene methylene blue imagwirira ntchito m'maselo kumapereka mfundo yomweyi mwachidule: zochita za redox zimakhudza zinthu zambiri, koma zotsatira pa zamoyo zimadalirabe mtundu wa chamoyo ndi malo amene chili.
Choncho siyanitsani mafunso awiri. Loyamba, kodi methylene blue imachita chiyani ku Borrelia wokulitsidwa m'mikhalidwe yoyendetsedwa bwino. Lachiwiri, kodi chimachitika n'chiyani mwa anthu omwe ali ndi matenda a Lyme. Nkhani yotsalayi ikutsatira dongosolo limenelo.
Tizilombo topirira timakhala mumkhalidwe winawake, si mtundu wamphamvu kwambiri
Mankhwala opha mabakiteriya nthawi zambiri amapha Borrelia ambiri mwachangu n'kusiya gulu laling'ono lopirira. Ofufuza atakulitsanso tizilombo totsalato, tizilombo timene tinachokera mwa iwo nthawi zambiri tinkaphanso ndi mankhwalawo. Zimenezi zimasonyeza mkhalidwe wa kagwiridwe ka thupi womwe ungabwerere mmene unalili, osati kukana mankhwala kobadwa nako. Chitsanzo chomveka bwino chikupezeka mu ntchito ya Sharma ndi anzake yokhudza kupha m'magawo awiri ndi kukulanso kwa tizilombo topirira.
Nthawi zambiri, tizilombo tangoyamba kukulitsidwa tomwe tili m'gawo la kuchulukana mofulumira timakhala makamaka mabakiteriya opindapinda omwe amayenda, ndipo timakhudzidwa mosavuta ndi mankhwala ovomerezeka. Tizilombo takhala tikukulitsidwa kwa nthawi yaitali, tomwe tili m'gawo losachulukana, timakhala ndi matupi ozungulira ambiri komanso timagulu ta tizilombo tolumikizana, ndipo timapirira mankhwala omwewo bwino kwambiri. Mawu amenewo amafotokoza maonekedwe ndi mikhalidwe ya kukula m'chotengera. Si umboni wakuti maonekedwe omwewo ndi amene amafotokoza zizindikiro zopitirirabe matenda a Lyme atachiritsidwa.
Njira yothandiza yomvetsera zimenezi ndi yosavuta. Kukula mwachangu kumapangitsa kuti njira monga kupanga khoma la selo zizikhudzidwa ndi mankhwala. Kukula pang'onopang'ono kapena mosiyana kumabisa njira zimenezo. Chinthu chothandiza polimbana ndi mkhalidwe wachiwiri chingakhale chosafunika pa woyamba, ndipo zimenezi zingakhalenso choncho mosinthana.
Zimene kafukufuku woyesa zinthu zambiri wa 2015 anapezadi
Kafukufuku amene amatchulidwa kwambiri pa nkhaniyi ndi kuyesa zinthu zomwe zinali m'gulu la FDA kochitidwa mu 2015 ndi Feng ndi anzake. Anayesa zinthu pa Borrelia amene anali atakulitsidwa kwa masiku asanu ndi awiri ndipo anali m'gawo losachulukana, kwa masiku ena asanu ndi awiri. Chinthu chilichonse choyesedwa chinali pa 50 micromolar.
Methylene blue inagwira ntchito mokwanira kuti ikope chidwi, koma sinali chinthu chomwe chinapha tizilombo tonse. Poona ndi maikulosikopu, pafupifupi 40 peresenti ya maselo inatsala ili yamoyo pambuyo pa methylene blue, poyerekeza ndi 93 peresenti m'gulu losalandira mankhwala, 75 peresenti pambuyo pa doxycycline, 76 peresenti pambuyo pa amoxicillin, 49 peresenti pambuyo pa cefuroxime, ndi 35 peresenti pambuyo pa daptomycin yomwe inagwiritsidwa ntchito poyerekezera. Zotsatira za methylene blue zochokera pa chipangizo chowerengera mbale zoyesera sizinagwiritsidwe ntchito chifukwa mtundu wake wamphamvu unasokoneza kuyesa kwa kuwala kwa fluorescence, choncho mfundo yomaliza inadalira kuyang'ana mwachindunji ndi maikulosikopu.
Chimenecho ndi chizindikiro chochokera pa kuyesa koyambirira, osati kuthetseratu tizilombo. Sizinasonyezedwe kuti Borrelia amene anapatsidwa methylene blue anakhalabe opanda tizilombo tamoyo atawasamutsira m'malo atsopano opanda mankhwala n'kuwakulitsa kwa nthawi yaitali. Olemba anapempha kuti pambuyo pake pachitike kafukufuku wa mankhwala osakaniza ndi wa nyama, ndipo kumeneko ndiye kumvetsa koyenera kwa kuyesa gulu la zinthu zambiri.
Chifukwa chake n'zosavuta kumvetsa molakwika zotsatira za mankhwala osakaniza
Kafukufuku wina wokhudzana ndi nkhaniyi wa 2015 nthawi zambiri amasakanizidwa ndi zonena zomwezo. Mu kafukufuku wa Feng, Auwaerter, ndi Zhang wokhudza mankhwala osakaniza polimbana ndi Borrelia wa m'gawo losachulukana, zotsatira zamphamvu kwambiri za mu labotale zinachokera ku daptomycin pamodzi ndi doxycycline ndi cefoperazone, iliyonse pa 10 micrograms pa milliliter kwa masiku asanu ndi awiri. Pambuyo pa chithandizo, mankhwalawo anachepetsedwa mphamvu posamutsira m'malo atsopano okulitsira, ndipo tizilomboto tinaonedwa kuti tidziwe ngati tikukulanso.
Kusakaniza mankhwala atatu kumeneko kokha ndiko kunakhala kopanda tizilombo topezeka pambuyo pa masiku 15 a kukulitsa m'malo atsopano. Malire otchulidwa a zimene maikulosikopu akanatha kuzindikira anali pansi pa tizilombo 100,000, choncho “kuthetseratu” kunatanthauza kuti panalibe kukulanso kooneka ndi maikulosikopu potsatira ndondomeko imeneyo. Sikunatanthauze kutsimikizira kuti panalibe ngakhale tizilombo timodzi tamoyo, kuti mankhwalawo amafika m'zigawo za thupi la nyama, kapena kuti amachiritsa munthu. Pepala la kafukufukulo linachenjeza lokha kuti zotsatirazo zisagwiritsidwe ntchito mwachindunji pa chithandizo.
Zotsatira za pambuyo pake zokhudza methylene blue yosakanizidwa ndi mankhwala ena zinachokera pa umboni wa mtundu wina komanso wofooka kwambiri. Kafukufuku wa digiri ya masters wa 2016 wa Megan Weitner ku Johns Hopkins anayesa methylene blue pa 4 micrograms pa milliliter, kuchuluka kosankhidwa poganizira kuchuluka komwe kungafike m'madzi a m'magazi, pamodzi ndi mankhwala monga cefuroxime, doxycycline, azithromycin, rifabutin, rifaximin, nitrofurantoin, ndi pyrimethamine. Tizilombo tinayikidwa m'mankhwalawo kwa masiku asanu ndi awiri ndipo tinaunikidwa pogwiritsa ntchito utoto ndi maikulosikopu. Magulu osakaniza omwe chiwerengero chawo chosinthidwa cha maselo otsala amoyo chinali pansi pa 0.90 anatchedwa ogwira ntchito. Mwachitsanzo, methylene blue pamodzi ndi azithromycin zinafika pa 0.88, ndipo chiwerengerocho chinatsika kufika pa 0.64 pamene cefuroxime inawonjezedwa, pamene magulu ena angapo a mankhwala atatu anafika pafupifupi pa 0.69 mpaka 0.82.
Zimenezo ndi kuchepa kwa chizindikiro chochokera ku utoto, osati kupha tizilombo tonse m'chotengera chokulitsira. Kafukufuku wa digiriyo sanasonyeze kusapezeka kwa tizilombo kwa nthawi yaitali m'magulu a methylene blue yosakanizidwa ndi mankhwala ena, kofanana ndi zotsatira za mankhwala atatu okhala ndi daptomycin. Komanso ndi kafukufuku wa digiri, osati pepala la m'magazini ya kafukufuku lomwe launikidwa ndi akatswiri ena. Ungapereke malingaliro oti ayesedwe. Sungakhale ndi mphamvu yofanana ndi umboni wa kafukufuku wa odwala wokhala ndi gulu loyerekezera.
N'chifukwa chake “ndondomeko ya methylene blue ya Lyme” singatengedwe kuchokera m'mapepalawa. Kuyesa kwa mu labotale komwe kumayika tizilombo m'mankhwala mosalekeza kwa masiku asanu ndi awiri sikutchula mlingo wa munthu, njira yoperekera, nthawi, kuchuluka komwe kumafika m'zigawo za thupi, kapena kuchuluka kwa poizoni kovomerezeka. Sikuyesanso methylene blue yokha potengera zotsatira zofunika kwa odwala, monga ululu, kutopa, kutupa kwa mfundo, zizindikiro za mitsempha ya ubongo ndi thupi, kapena kubwereranso kwa matenda. Kuti muthandizidwe kusiyanitsa milingo imeneyi ya umboni, onani malangizo athu owerengera zonena za kafukufuku wa methylene blue.
Kuchokera m'zotengera kupita kwa odwala: gawo la kafukufuku wa odwala lomwe likusowa
Pa nthawi yolemba nkhaniyi, palibe mayeso a odwala ogawidwa mwachisawawa m'magulu kapena kafukufuku wotsatira odwala kupita m'tsogolo wokhala ndi gulu loyerekezera, wosonyeza kuti methylene blue imachiza matenda a Lyme. Zomwe zilipo mwa anthu ndi malipoti opanda gulu loyerekezera, momwe methylene blue inali mbali imodzi ya ndondomeko ya mankhwala angapo.
Chitsanzo chomveka kwambiri ndi kafukufuku woyang'ana mmbuyo pa chithandizo cha dapsone yosakanizidwa ndi mankhwala ena, wochitidwa ndi Horowitz, Fallon, ndi anzawo, kuphatikizapo lipoti la 2023 la odwala 25 omwe anali atalandira kale chithandizo chambiri. Ananena kuti zizindikiro za Lyme zomwe zinalipo mwa 8 mwa odwala 25 zinatha kwa miyezi yosachepera itatu. Koma odwalawo analandiranso dapsone, tetracyclines, rifampin kapena rifabutin, macrolides, komanso nthawi zina mankhwala ena. Panalibe gulu lopatsidwa methylene blue yokha ndiponso panalibe gulu loyerekezera losankhidwa mwachisawawa. Malipoti ang'onoang'ono a odwala omwe anatuluka pambuyo pake ali ndi kapangidwe komweko.
Kapangidwe kameneko kangafotokoze zotsatira. Sikingatsimikize kuti methylene blue ndiyo yabweretsa zotsatirazo. Kusintha kwabwino kungakhale chifukwa cha mankhwala ena, kusakaniza mankhwalawo, mmene matendawo amayendera mwachibadwa, zotsatira za kukhulupirira kuti chithandizo chikugwira ntchito, kuyang'aniridwa kwambiri, kapena kusankha odwala omwe akanatha kusintha bwino. Tebulo likumveketsa kusiyana kumeneku.
| Kafukufuku ndi kapangidwe kake | Zimene zinayesedwa | Zotsatira za mu labotale kapena mwa odwala | Zimene sizikusonyeza |
|---|---|---|---|
| Feng ndi anzake 2015, kuyesa pa gawo losachulukana | Methylene blue 50 micromolar kwa masiku 7 | Pafupifupi 40 peresenti ya maselo inatsala yamoyo poona ndi maikulosikopu | Kuthetseratu tizilombo, mlingo wa mankhwala, kapena phindu kwa wodwala |
| Feng ndi anzake 2015, tizilombo tokulitsidwa ndi mankhwala osakaniza | Daptomycin, doxycycline, ndi cefoperazone | Palibe kukulanso kopezeka pambuyo pa kukulitsa m'malo atsopano kwa masiku 15 | Kuti methylene blue imafika pa zotsatira zomwezo |
| Kafukufuku wa digiri wa Weitner 2016, tizilombo tokulitsidwa ndi mankhwala osakaniza | Methylene blue 4 micrograms pa milliliter pamodzi ndi mankhwala ena | Chiwerengero chosinthidwa cha maselo otsala amoyo cha pafupifupi 0.59 mpaka 0.88 kutengera mankhwala ena osakanizidwa nawo | Zokulitsidwa zopanda tizilombo tamoyo kapena kugwira ntchito kwa chithandizo mwa odwala |
| Malipoti a gulu la odwala pa ndondomeko ya dapsone, odwala 25 | Ndondomeko za mankhwala angapo zokhala ndi methylene blue | 8 mwa 25 omwe zizindikiro zawo zinatha kwa miyezi yosachepera 3 | Kuti methylene blue ndiyo inachititsa kusintha kwabwinoko |
| Umboni umene malangizo a IDSA amadalira | Mankhwala ovomerezeka opha mabakiteriya pa maonekedwe odziwika a Lyme | Mayeso a anthu amathandizira ndondomeko za masiku 10 mpaka 28 kutengera mmene matendawo aonekera | Kuthandizira ndondomeko zolunjika pa tizilombo topirira kapena zogwiritsa ntchito utoto |
Choncho umboniwu ndi kuyesa koyambirira, kuphatikizapo mankhwala osakaniza mu kafukufuku wa digiri, kuphatikizapo malipoti a mankhwala angapo opanda gulu loyerekezera. Mndandanda umenewo ndi wofooka kuposa kusonyeza kuti chithandizo chimagwira ntchito mu mayeso a odwala.
Palibe yankho lochokera pa umboni la nthawi yomwe munthu ayenera kumwa
N'zomveka kuti anthu amafufuza “nthawi yomwe ayenera kumwa methylene blue chifukwa cha Lyme.” Zizindikiro zopitirirabe zimakakamiza munthu kufunafuna chochita. Koma kunena nthawi yoti agwiritse ntchito mankhwala kumafuna kuti pakhale kale mlingo wotsimikiziridwa kuti umagwira ntchito, ndipo palibe mayeso omwe atsimikizira mlingo wotero pa Lyme.
Methylene blue ndi mankhwala omwe amagwira ntchito m'thupi lonse ndipo ali ndi zoletsa zenizeni. Chizindikiro cha ku U.S. cha mankhwala operekedwa ndi dokotala pa methemoglobinemia yobwera pambuyo pobadwa chimafotokoza 1 mg pa kg kudzera mumtsempha kwa mphindi 5 mpaka 30, pa matenda ena, njira ina yoperekera, ndi cholinga china, zomwe sizingasinthidwe kukhala mlingo wa Lyme. Zolemba za mankhwalawa zili ndi chenjezo lapadera m'bokosi lokhudza serotonin syndrome pamene methylene blue yasakanizidwa ndi mankhwala okhudza serotonin, makamaka SSRIs, SNRIs, ndi mankhwala oletsa MAO, ndipo zimaletsa kugwiritsidwa ntchito kwa anthu omwe ali ndi kusowa kwa G6PD chifukwa cha chiopsezo cha kuchepa kwa magazi chifukwa cha kuwonongeka kwa maselo ofiira. Aliyense amene akuganiza zogwiritsa ntchito mankhwalawa akufunika kuti katswiri wa zachipatala aunikire mankhwala ake, momwe G6PD ilili, mimba, kagwiridwe ka impso, ndi mmene mankhwala angakhudzire ena akagwiritsidwa ntchito pamodzi. Chidule chathu cha chitetezo ndi kagwiritsidwe chimafotokoza chifukwa chake kuyera kwa mankhwala ndi kuyang'aniridwa ndi katswiri wa zachipatala n'kofunika asanagwiritsidwe ntchito m'thupi lonse.
Pa zizindikiro zomwe zikupitirirabe pambuyo pa chithandizo chovomerezeka cha Lyme, popanda umboni wotsimikizika wa kutenganso matenda kapena kulephera kwa chithandizo, malangizo a IDSA amalangiza kuti pasaperekedwe mankhwala ena opha tizilombo. Amanenanso kuti palibe umboni wa kafukufuku wa odwala wothandizira ndondomeko zolunjika makamaka pa maselo opirira kapena omwe asintha maonekedwe. Zimenezo sizikukana kuti maselo opirira alipo m'zotengera zokulitsira. Zikunena kuti kulumikiza zimenezo ndi umboni wa odwala sikunachitikebe.
Njira yothandiza powerenga zonena zotsatira zomwe mudzakumane nazo ndi kufunsa mafunso atatu. Kodi zotsatirazo zinali m'tizilombo tokulitsidwa m'madzi a zakudya, m'nyama, kapena mwa odwala. Kodi methylene blue inayesedwa yokha kapena inali m'kusakaniza mankhwala angapo kokha. Kodi choyezedwacho chinali kukulanso m'chotengera kapena kuchira kwa anthu. Ngati mayankho ake ndi chotengera, kusakaniza, ndi kukulanso, ndiye kuti kafukufukuyo amapereka malingaliro oti ayesedwe. Si ndondomeko ya chithandizo.